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General NPI Number Information
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NPI Number | 1619484102
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Entity Type | Organization
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Legal Business Name | ALIGN INTEGRATED MEDICAL LLC
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 07/07/2020
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Provider Practice Location Address
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Address Line | 750 W USTICK RD STE 100
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City | MERIDIAN
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State | ID
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Zip | 83646
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Country | US
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Telephone | 208-639-1397
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Fax |
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Provider Business Mailing Address
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Address Line | 750 W USTICK RD STE 100
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City | MERIDIAN
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State | ID
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Zip | 83646-6133
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Country | US
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Telephone | 208-639-1397
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHAD WOOLNER
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Credential |
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Telephone | 208-639-1397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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